We performed bilateral ultrasound-guided erector spinae plane blocks at the second and eighth thoracic vertebrae in 11 fresh frozen cadavers. Methylene blue dye spread variably and extensively deep to the erector spinae muscles fascia with involvement of the spinal rami and paravertebral space in 1 of 11 cadavers when injected at the eighth thoracic vertebra, and in 4 of 11 cadavers at the second thoracic vertebra, with crossover to the contralateral side of the spine. Our study demonstrates that in cadavers, an erector spinae plane block follows the fascial planes with unpredictable spread, which might explain its varying clinical efficacy.

No abstract

Pain partially responsive to opioids can lead to rapid escalating dosages due to tolerance development. In this report the case of a 58-year-old female with neuropathic pain using increasing transdermal (TTS) fentanyl dosages to a maximum dose of 3400 microg/h resulting in fentanyl plasma levels of 173 ng/ml is described. For pain relief an epidural infusion at the level T1-2 with bupivacaine was started. Immediate pain relief was accompanied by short lasting respiratory depression and drowsiness.

We describe a patient with an intracerebral haemorrhage following an accidental dural puncture during an attempted epidural for pain relief in labour. Anaesthetists need to include intracerebral haemorrhage in the differential diagnosis of post-dural puncture headache in the puerperium.

After an infusion of propofol, patients excrete propofol and its metabolites in the urine over a period in excess of 60 h. We hypothesize that (re)absorption of propofol and its metabolites by the kidney is a major process in elimination and that the reabsorbed compounds are gradually conjugated in the kidney and excreted in the urine. One patient showed a different pharmacokinetic profile for which we currently have no explanation.